Tuesday’s Forum

FILED UNDER: Open Forum
Steven L. Taylor
About Steven L. Taylor
Steven L. Taylor is a Professor of Political Science and a College of Arts and Sciences Dean. His main areas of expertise include parties, elections, and the institutional design of democracies. His most recent book is the co-authored A Different Democracy: American Government in a 31-Country Perspective. He earned his Ph.D. from the University of Texas and his BA from the University of California, Irvine. He has been blogging since 2003 (originally at the now defunct Poliblog). Follow Steven on Twitter

Comments

  1. OzarkHillbilly says:

    Covid-19 cases in Florida have risen by 948% in just two weeks, as the highly transmissible Omicron variant drives a huge wave of infections and hospitalizations across the US.

    Even as Dr Anthony Fauci – Joe Biden’s top medical adviser – cautioned the public to look at hospitalizations and not infections in order to gauge Omicron’s severity, the seven-day average for US patients hospitalized with Covid-19 increased by more than 40% during the week between Christmas and New Year’s Eve.

    Cases have risen by more than 100% nationally, despite tests being in short supply in many areas, and infections have doubled in the last seven days to an average of 418,000 a day, according to a Reuters tally.

    In Florida, local and state officials warned that residents were waiting hours in sometimes miles-long lines just to get a test. Some accused the state health department and the governor, Ron DeSantis, of being missing in action.

    “It’s every man/woman for themselves, because leadership is MIA,” tweeted state senator Shevrin Jones.

    Evidence suggests Omicron is a more mild if highly infectious variant. But it “will still do terrible damage among the unvaccinated in both the US and worldwide”, according to the New York Times.

    Mask up.

    ReplyReply
    1
  2. OzarkHillbilly says:

    Thirty years ago, when Li Jingwei was four years old, a neighbour abducted him from his home village in China’s Yunnan province and sold him to a child trafficking ring.

    Now he has been reunited with his mother after drawing a map of his home village from his memories of three decades ago and sharing it on a popular video-sharing app in the hope that someone might be able to identify it.

    “I’m a child who’s looking for his home,” Li said in the video. Unable to recall the name of his village or his address, Li’s recollection and reconstruction of the village’s key features – including a school, a bamboo forest and a pond – proved crucial.

    “I knew the trees, stones, cows and even which roads turn and where the water flows,” Li said in an interview with the Paper, a Chinese media outlet.

    Shared on Douyin – known outside China as TikTok – on 24 December, the map was matched by police to a Yunnan village where there was a woman whose son had disappeared.

    That son was identified as Li through DNA tests, leading to an emotional reunion on Saturday. Video footage showed Li carefully removing his mother’s mask to examine her face before breaking down in tears and embracing her.

    OK Ok, there is an upside to this brave new techno world.

    ReplyReply
    7
  3. OzarkHillbilly says:

    Cheryl Rofer
    @CherylRofer

    Seems like a good day to repost this

    Heh.

    ReplyReply
    3
  4. MarkedMan says:

    Yesterday, I asked if anyone still disagreed with my oft expressed view that Trump is, and always has been, a moron. Cracker had some interesting pushback, and I realized we may once again get into a discussion that was, at its core, just a debate about definitions. So I’m going to explain what I mean by “The most important thing to remember about Trump is that he is a moron”.

    I lived in NYS from the late 70’s to the late 80’s, and have lived and worked in and around the greater NYC area roughly another dozen years, so I’m fairly familiar with Trump from his earliest days. One thing that became obvious even from the earliest is that Trump has never said anything that gives any evidence that he has more than the barest surface understanding of anything. Even when Trump was being interviewed by a business magazine, where you could expect at least a moderately technical discussion, his discussion of real estate or construction was at the very surface level. For instance, in the 80’s and 90’s you might hear an actual real estate magnate discuss (and I’m just making this up – I’m not a real estate magnate) the difficulties that arise because of the interior concrete and rebar construction of the post-war era make a re-furb more expensive when you have to run upgraded electric, put in networking cable and add fire suppression equipment. But with Trump it was all vague and surface, albeit over the top. This opportunity was “the greatest”. He only did “the best deals”. He knew the real estate and construction market better than anyone. Stuff like that, nothing specific. Listen to him talk about anything, anything at all, and there is no there, there. And, after four decades or more, I gotta believe that if I’ve never come across any instance of him expressing useful knowledge of, well, anything, then he probably doesn’t have any to express.

    In fairness, I have vague recollections that in the early 80’s he talked a bit more in depth, but my impression was that he either spoke in the broadest generalizations (“There’s still a lot of opportunity on the west side”) or he just repeated something he had heard and then waited for the interviewer to react, (“A lot of people are saying interest rates are going to go up and that’s going to affect the re-mortgaging business”).

    I think he gave up even trying to fake deep understanding after this disastrous interview.

    ReplyReply
    4
  5. OzarkHillbilly says:

    @MarkedMan: I’m with you and always have been. He has an innate ability to sense what people react to, and either attack or appease based on his motivations of the moment, but behind it lies a void of ignorance that never rises above his immediate desires.

    ReplyReply
    2
  6. CSK says:

    @MarkedMan: @OzarkHillbilly:

    http://www.theweek.com/articles/915606/trumps-lethal-aversion-reading

    That interview with Pat Buchanan was hilarious.

    ReplyReply
    2
  7. MarkedMan says:

    @CSK: Good link. From that article:

    Reading — even about oneself — requires focus, and Trump has none. “It’s impossible to keep him focused on any topic, other than his own self-aggrandizement, for more than a few minutes,” Schwartz said.

    Trump’s non-reading evinces not stupidity so much as incuriosity. Narcissists are easily bored, and Trump is no exception. In his 1990 book, Surviving at the Top, which he didn’t write, Trump says that travel, exercise, and successful people bore him. “I get bored too easily,” he says. “My attention span is short.”

    Trump’s former National Economic Council director Gary Cohn allegedly wrote in an email, “Trump won’t read anything — not one-page memos, not the brief policy papers; nothing. He gets up halfway through meetings with world leaders because he is bored.”

    The only information that interests Trump is information that affirms his self-image. He’s rich, handsome, and popular — that’s what he wants to hear, which is why he regularly says it himself.

    Trump, we are told, processes information orally. If you process information orally, you likely process little information. And if you process little information, you exude even less. Every time Trump comments on a subject, he reveals how little he knows about it. He wondered aloud why the Civil War was fought. He said he’s been treated worse than Abraham Lincoln, who was assassinated. He didn’t know what happened at Pearl Harbor. He’s too dumb to know he’s ignorant, and he’s too narcissistic to care.

    Trump is one of the more animalistic people I’ve come across. Appetites and impulses. Nothing more.

    ReplyReply
    5
  8. gVOR08 says:

    And another one bites the dust. OTB policy is to respect the departed, so I’ll only note that when she and any other victims of the TPUSA conference reach the Pearly Gates, they should be accounted suicides.

    ReplyReply
    4
  9. CSK says:

    @MarkedMan:
    Indeed. I’ve heard the phrase “creature of appetite” used to describe certain people, and it fits Trump to a t.

    ReplyReply
    2
  10. Michael Reynolds says:

    Axios:

    Elected officials, a major newspaper and the oldest Latino civil rights organization in the U.S. have all spoken out strongly in recent weeks against the continued use of “Latinx,” the gender-neutral term promoted by progressives to describe people of Spanish-speaking origin.

    ReplyReply
    3
  11. Jen says:

    The US has set a world record of the single largest covid case count in a day, of over a million Covid-19 cases yesterday. Highest daily record of any country, at any point in the pandemic.

    Sigh.

    I think the US is about to go through some things.

    ReplyReply
    1
  12. Michael Reynolds says:

    @MarkedMan:
    I’ve defined him from day one as a ‘stupid psychopath.’ He’s not Blofeld, he’s an intellectually paper-thin fuckwit who turned a bunch of daddy’s money into less money than if he’d just stuck it all in mutual funds.

    ReplyReply
    4
  13. Beth says:

    @MarkedMan:

    I was having a discussion with my Father in Law over Christmas about real estate and I remarked something to the effect of “real estate developers are some of the dumbest people I know, they are almost all morons”. The look off offense he gave me was like I just told him his daughters were ugly. He was like, “But they have money!!!!!!” So what, all of them, even the smart ones were really good sales people and could work a loan officer as well as a buyer. Almost all of them crash and burn because they eventually burn through all of the banks and contractors by robbing Peter to pay Paul. Hell, I know two of them that didn’t know the basics of a real estate closing.

    He finally patted me on the shoulder and knowingly chuckled, “we’re just going to have to disagree…” He’s a retired middle manager that was forced out of work because of age and I’m a real estate lawyer. But he’s a Republican so he knows more than me.

    ReplyReply
    5
  14. steve says:

    Our number of Covid admissions are at record levels. We matched the record on Friday and every day since it has increased by about 10% per day. Record numbers of people being held in our EDs. On the positive side the number of pts in the ICU with covid is still about 40% less than our peak but it is still a lot so ICU beds are tight. About 80%-85% are unvaccinated. Of those who have been vaccinated many are immunocompromised in some manner. Surrounding networks are shutting down some elective care and I think we are close to doing that also. It remains largely driven by our rural patients.

    Steve

    ReplyReply
    2
  15. CSK says:

    @Michael Reynolds:
    And yet he always careful to remind us–constantly–that he went to one of the “top schools.”

    Wharton Professor of Marketing William T. Kelley on Trump: “The dumbest goddamn student I ever had.”

    ReplyReply
    4
  16. OzarkHillbilly says:

    @gVOR08: OTB policy is to respect the departed,

    Where has that been written? If I didn’t respect them when they were alive, how the hell can I respect them when they’re dead?

    ReplyReply
  17. Kathy says:

    @Beth:

    I’m puzzled how money, a tool that changes hands so often it picks up every pathogen known and many unknown, became such a powerful sanitizing agent.

    ReplyReply
    2
  18. MarkedMan says:

    @CSK: This bit of reminiscing on Trump’s IQ has got me wondering…

    I always assumed he could read because there are many anecdotes from the 80’s and 90’s of Trump calling up reporters to thank them for this article or that on him. The reason the reporters were bringing this up was that the articles were usually negative and disparaging. Their take away was that Trump believed that any publicity was good publicity. Bit what if that is wrong? What if he didn’t know the articles were negative because he hadn’t read them?

    ReplyReply
    1
  19. HarvardLaw92 says:

    On a brighter note, Devin Nunes is finally officially out of Congress.

    ReplyReply
    6
  20. OzarkHillbilly says:

    @HarvardLaw92: I’ll bet his cows are happy to have him home again.

    ReplyReply
    3
  21. JohnSF says:

    On the intellect of Donald Trump.
    I tend to think, kind of like a shark; not the smartest of fish, but with a keen nose for the main chance.
    I’ve met one or two businessmen and local politicians, and for that matter musicians, a bit like that: really slick in their chosen field of operations, but effectively a dumb as a rock outside it.
    Virtually no general curiosity, very little generalised empathy, except in self-serving way.

    You can also see his pattern in “speeches”: he rambles through topics until one gets feedback from the audience, then he riffs on that, with little content but a good sense of how to play on emotional responses.

    And also when some idea does get fixed in his noggin, whether how to negotiate with Kim Jong Un, or a pet covid therapy, or how tariffs work, doesn’t matter how often it turns out to be plainly wrong, he’ll circle back to it again.

    Perhaps not so much plain stupidity, but incuriosity, short-termism, indifference to actualities and most other people, and being too lazy to bother thinking things through.

    ReplyReply
    4
  22. Stormy Dragon says:

    I finally got a PCR test, so the illness I’ve just gotten is neither COVID19 nor influenza.

    ReplyReply
    3
  23. CSK says:

    @MarkedMan:
    I think you’re onto something here. There are three possibilities. The first is that he had someone read them to him, and that individual censored the bad parts. The second is that he saw his name in the papers and was satisfied with that. The third is that he didn’t, back then, believe that there was any such thing as bad publicity.
    @JohnSF:
    Yep.

    ReplyReply
    1
  24. Kathy says:

    @CSK:

    I think his reading skills extend to single Twits, no more. This would explain his Twit storms when he came across any negative comments about him.

    Or he may be one of those who reads or hears what they expect or want, not what’s said or written. For instance, If I were to tell him “Benito, your’e the greatest failure ever,” he may reply “Thanks. I’ve always known I’m the greatest, many people say that.”

    ReplyReply
  25. CSK says:

    @Kathy:
    Trump has all the symptoms of untreated ADHD, and an inability to focus on the written word is one of them.

    ReplyReply
    3
  26. gVOR08 says:

    @MarkedMan:

    Their take away was that Trump believed that any publicity was good publicity.

    Molly Ivins had a story about calling some Texas pol a knuckle dragging Neanderthal or something equivalent, only to run into the guy a couple days later. She’s mentally cowering as the guy runs over, smiles, hugs her, and thanks her for putting his name in her paper. Gawd I wish Molly hadn’t died. We need her.

    ReplyReply
    2
  27. Sleeping Dog says:

    @gVOR08:

    When asked about the relentless beating that the Manchester Union Leader was giving him in the 72 primary, George McGovern was quoted “as long as they spell my name right” George knew that the voters he wanted would view the UL coverage as a reason to vote for him.

    ReplyReply
  28. grumpy realist says:

    Hmm. What do you want to bet that this individual wasn’t vaccinated, either?

    I just can’t feel sorry for people who refuse to take sensible precautions.

    ReplyReply
  29. grumpy realist says:

    Here’s another case, of a couple who are now stuck in Italy because of developing COVID. I can’t figure whether to class this under “First World people’s problems” or “you assumed the risk, no?”

    I also note that the article carefully fails to mention if they’re vaccinated or not. Hmmm.

    ReplyReply
  30. CSK says:

    @grumpy realist:
    Ernby was adamantly opposed to vaccine mandates, I know that much.

    ReplyReply
  31. Sleeping Dog says:

    @grumpy realist:

    The article did say they were vaxxed, but didn’t indicate if it was 2 shots plus booster.

    ReplyReply
  32. OzarkHillbilly says:

    @JohnSF: incuriosity, short-termism, indifference to actualities and most other people, and being too lazy to bother thinking things through.

    Or to put it another way, a complete moron.

    ReplyReply
    1
  33. CSK says:

    @OzarkHillbilly:
    But a dangerous moron.

    Am I the only person who’s wondering–with some trepidation–what he’s going to say and do at his Jan. 6 commemorative press conference this coming Thursday? Incite another riot?

    ReplyReply
  34. Just nutha ignint cracker says:

    @MarkedMan: Under that definition, yeah, FG would be a moron. I wasn’t thinking in that type of context when I replied. Again, I’ve worked with a lot of people over the years who had only the most shallow understanding of their fields (and life at large for that matter) and would only have called them morons as a pejorative. I don’t care enough about FG to spend the energy pejorizing him.

    But please feel free to, if you do! 😉

    ReplyReply
    3
  35. Just nutha ignint cracker says:

    @CSK: From the article: “White House trade adviser Peter Navarro wrote a memo in January warning of “a full-blown coronavirus outbreak on U.S. soil.” Trump said he didn’t see it because “Peter sends a lot of memos,” none of which he reads.

    “After failing to read about the coronavirus, Trump failed to respond to it. It’s not a stretch to say that if the president read, thousands of lives might have been saved.” [emphasis added]

    I would still hold that it is a stretch because I have no compelling reason to believe that simply reading something would have prompted action

    ReplyReply
    2
  36. Just nutha ignint cracker says:

    @gVOR08: “On Dec 4, she [Kelly Ernby] spoke against vaccination mandates at a Turning Point USA rally. She subsequently became ill.”

    Hm… What a strange coincidence.

    ReplyReply
  37. CSK says:

    @Just nutha ignint cracker:
    No, it wouldn’t. Trump believes what he wants to believe.

    ReplyReply
  38. JohnSF says:

    @OzarkHillbilly:
    Ha!
    Got me. 🙂
    But it’s a bit like there is a spectrum, and Trump is near one extreme of it, from”high functioning fool”; a.k.a. willfully stupid, to “political savvy sociopath” who can be successful democratic politicians.
    (As opposed to autocrats/dictators, which is different skill set, and usually played for much higher stakes)

    A true, full-time, natural born moron would not have Trump’s periodic capability for successful manipulations of crowd psychology, exploitation of the the political vulnerabilities of rivals, slippery ambiguity of speech, exploitation of legal loopholes, and above all, the ability to sniff a grift a mile off.
    Mostly instictive, but nonetheless effective: Mr Shark

    Johnson has some similarities in terms of laziness, disorganisation, low boredom threshold, rejection of imposed limits and conventions, dishonourable, indifferent to truth.
    OTOH Johnson is (when he chooses to be) cleverer by a long way, more persuasive in person, less gratuitously nasty, less the embodiment of trolling.
    Orban probaly belongs around the mid of this line also.
    More your vulture type, maybe?

    Berlusconi closer to the “savvy sociopath” end of the line. A bigger crook and better businessman than either Trump or Johnson, but more inclined to self-discipline when required, and far more capable at strategic rather than purely tactical politics.
    About the fox or weasel level. 🙂

    ReplyReply
    2
  39. flat earth luddite says:

    Yet another reason for me to not relocate to Alabama-stan:

    A north Alabama lawmaker who has tried unsuccessfully to repeal the requirement for a permit to carry a concealed handgun said support is growing and he believes his bill will pass next year.

    Rep. Andrew Sorrell, R-Muscle Shoals, has 38 co-sponsors for the bill this year, compared to about six to eight he had when he first sponsored the bill in 2019. Sorrell has pre-filed the bill in advance of the legislative session.

    If I’m understanding his position correctly, requiring you to get a permit to carry concealed is a violation of your 2nd Amendment right to carry whatever the fquk you wanna carry, whenever and however you want to pack it. Oh ferf**ksake!

    ReplyReply
    2
  40. Kathy says:

    Any word on the GQP covidiots who thought they have anthrax? Have they hit the 20 to 80% mortality rate yet?

    ReplyReply
    1
  41. Just nutha ignint cracker says:

    @grumpy realist: From paragraph 3:
    “Now the North Texas couple, who are fully vaccinated, are waiting in a cramped hotel room in the mountain city of Montecatini Terme for word from the Italian government or U.S. Embassy officials about what happens next.”
    [emphasis added]

    ReplyReply
    1
  42. mattbernius says:

    This request from the Jan 6th investigation to Sean Hannity’s for his txts to the White House includes some txt’s gained from Meadows that demonstrate how much Hannity was a shadow advisor to the President. Of course Fox News won’t do anything about it it.

    Also, noteworthy is who those txts suggest that Hannity was concerned about Trump’s mental state in the last few days of his administration. I expect, after Trump shuffles off this mortal coil, that Hannity will write a tell-all memoir that casts himself as a hero helping to keep the Trump presidency together in its final days.

    https://january6th.house.gov/sites/democrats.january6th.house.gov/files/2022-1-4.BGT%20and%20LC%20Letter%20to%20Hannity_Redacted.pdf

    ReplyReply
  43. Just nutha ignint cracker says:
  44. Jax says:

    @Kathy: Last I heard, one of the organizers was on a ventilator, haven’t heard if he’s shuffled off this mortal coil yet.

    ReplyReply
    1
  45. Mister Bluster says:

    Trump cancels event planned for anniversary of Jan. 6 Capitol riot
    In a statement, Trump said he was canceling the event due to “the total bias and dishonesty” of the media and the House select committee investigating Trump’s role in the Jan. 6 attack.
    Instead, Trump vowed to discuss the same “important topic” at a rally in Arizona set for Jan. 15.

    ReplyReply
  46. Kathy says:

    @Jax:

    Hopefully he’s not taking it from someone who really needs it.

    ReplyReply
  47. CSK says:

    @Mister Bluster:
    I think that translates as “no one from the legitimate press is showing up for this clown show.”

    ReplyReply
    2
  48. Jax says:

    @Kathy: I can guarantee he is. I haven’t been on the Herman Cain Awards reddit for a few days, guess I’ll go look. I know he was nominated. 😛

    ReplyReply
  49. Jax says:

    This is not the same guy, but goddamn it, people like JKB and Ron DeFuckFace and Greg (triple-boosted before everybody else could be)Abbott, the entire “conservative” mediasphere (also mostly vaccinated and boosted), and every other COVID denier/anti-vaxxer piss me off. These people are dying because of the misinformation they are fed.

    There really ought to be a law. 😐 You shouldn’t be able to kill people and call it Freedom of Speech.

    Y’all wanted another COVID-19 story from the bedside. Here’s another one. It’s a little more intense
    Meta / Other
    Denial. Anger. Negotiation. Depression/sorrow. Acceptance. The five stages of grief. I learned about them briefly in paramedic school. We studied it with more application specifics in nursing school. It was covered a little more in depth in psychology 101. I learned that it’s not necessarily a linear process. People can bounce around through these stages, like a pinball, when severely strained. Regardless of what I know about it intellectually, as a critical care nurse, watching my patients and their family members go through it still can overwhelm me at times. Tonight was one of those nights.

    The patient that I’m thinking of was a male in his upper 50s with a previous medical history of high blood pressure and high cholesterol. He was not vaccinated against Covid-19. The patient’s spouse had been diagnosed with Covid-19 about 10 days prior, and, of course, he ended up sick as well. He came to the hospital after about a week of persistent fevers with worsening shortness of breath.

    When he got to the emergency department, his blood oxygen percentage levels (SpO2) were found to be abysmal, in the 50-60% range. A normal range is 92-99%. This is one of the features of significant Covid-19 sickness: the surprisingly low SpO2 levels far exceeding the presenting symptoms. The patient was admitted to the ICU on continuous positive pressure ventilation given by a pressurized mask with straps going around his head to hold it onto his face. We call it AVAPS, although that is technically the name of the advanced setting being used. He stabilized pretty well on that, and his SpO2 levels improved up to the range of 93-97%. Eventually he only needed AVAPS some of the time, and was stable on a high flow nasal cannula otherwise.

    The patient and his wife had multiple conversations with the critical care doctor, and he adamantly did not want to be placed on a ventilator if it came to that. Per his instructions, we would do anything and everything to help him recover, but if he stopped breathing, or if his heart stopped, we would only do comfort measures. We would not perform CPR or place him on a breathing machine. In our state, this is called a DNR-CCA.

    The first time I personally met him was his second day in ICU. I wasn’t his primary nurse, but he had put the call light on because the IV pump was beeping. We chatted for a bit while I fixed the problem, and he was pleasant, cooperative, and determined to get better. He looked uncomfortable, and I could tell that he wasn’t able to talk much because he still felt so short of breath. I smiled reassuringly as I told him that maybe he was over the hump, seeing as we had been able to make some progress on his oxygen requirements.

    An hour or two later, I heard his monitor alarms going off, so I went to check on him. His SpO2 had started dropping precipitously due to the exertion of using a urinal, and his primary nurse and the respiratory therapist were rushing to place him back on the AVAPS machine. By the time they had the pressurized mask strapped in place, his oxygen levels hit 39% for a brief second until he started recovering.

    Because of the layers of PPE required to enter the room, I stood outside the room and played charades with the nurse and respiratory therapist to see if they needed me to bring anything. His work of breathing had increased, and he looked exhausted. The nurse had me get a dose of morphine to give him in his IV. I handed it to her quickly through the door when she cracked it open.

    Morphine dilates respiratory passageways and blood vessels to maximize oxygen absorption, and reduces pain and/or anxiety. Reducing pain and anxiety can help reduce how fast the body is using oxygen. The combination of these effects usually helps slow the breathing down and make them not feel so short of breath.

    After about 5-10 minutes, he was back to above 90%. His primary nurse came out of the room, and we talked about his “code status,” which is medical jargon for how to intervene in the case of respiratory or cardiac arrest. Had he been okay with it, we would have placed a breathing tube and put him on a ventilator at this point, but we were following his decision to have a DNR-CCA order.

    Over the next few hours, the patient required being on AVAPS continuously. He could no longer tolerate any breaks on the high flow nasal cannula. Eventually the respiratory therapist had to turn up the oxygen level and the pressure delivery on the AVAPS as high as they could safely be turned in order to keep the oxygen saturation above 90%. The heart rate was increasing from the strain on his body.

    I started noticing frequent alarms from that room, alarms for high heart rate, low oxygen saturation, or high respiratory rate. The patient had to focus on slow and deep breathing to recover, which usually took several minutes. These alarms started sounding more frequently. First it was every half hour, then every 15 minutes, then every 5 minutes, and then it was almost constantly. At this point, he was nearly unable to recover into the SpO2 safe zone.

    With an hour left to go in my shift, I saw that the patient’s SpO2 had fallen below 80% and wasn’t coming up. I also knew that his AVAPS system was maxed out. There was nothing more that could be done from an oxygen delivery standpoint. I went to the room, along with the primary nurse, the critical care nurse practitioner and respiratory therapist. His breathing had become more and more labored. His respiratory effort now consumed him to the point that he was unable to speak. We gave morphine for air hunger several times with minimal effect.

    We called the family on an iPad video chat so they could see and talk to the patient. They didn’t understand how critical this was, and started teasing him a little “Come on, I didn’t think you’d let a little virus like this push you around! We’re all praying for you. Everyone in the church is praying, you’re going to be okay. You need to kick this little bug’s butt!”

    The patient initially gave a few slight nods to their comments, to let them know that he heard them, but otherwise sat there with his undivided attention on trying to breathe. His respiratory rate was around 40 really deep breaths per minute (normal is 15-20 regular breaths). Even though it was obvious to us that he could not sustain this respiratory effort for long, and that we had no way of stopping this runaway train, they tried to act cheerful and positive.

    Denial.

    Within 5-10 minutes, the patient had reached a point of absolute maximum effort, and had begun truly gasping for air. His shoulders and belly were heaving. Every single breath was a fight for survival, a panicked drowning victim frantically swimming with futility, unable to reach the surface of the water. We could hear him grunting with effort for every breath, the sound muffled by the pressurized mask strapped to his face. His skin became cold and grey, covered with a sheen of sweat. The SpO2 levels now stayed below 70%.

    The staff in the room looked at each other with grim certainty in our eyes. There was no turning back. There was no recovery from this. The virus had won. It had shredded his lungs beyond function to the point that his body was shutting down.

    His family asked why we can’t place him on a ventilator. The nurse practitioner explained that, aside from him specifically asking us not to, with the damage that had been done, it would only serve to prolong his dying and make him suffer longer. They asked what else we could do, what medications we could give, or how we can stop this. We told them that we had used every tool in the toolbox to help him get better already. There was nothing else to use.

    Negotiation.

    The family scrambled to get the children on the phone. They kept saying “It’s going to be okay! Everything is going to be fine. You’ll get through this!” But the tone of their voice had changed. They went from trying to talk to the patient into laughing with them, to trying to reassure him, to begging and pleading with him to stay alive, to utter despair. We gave him some more morphine, as well as some lorazepam for anxiety.

    Keeping the patient alive in this condition was only cruel. Keeping the pressure mask on his face was simply prolonging the inevitable. The patient’s eyes were rolling back in his head. There was no longer any sign of interaction. The only movement now was his body trying desperately to somehow draw in more oxygen to stay alive, and failing. We explained to the family that the compassionate thing to do would be to take him off AVAPS and see if he can say anything to them.

    More of the children got on the video call. One son could only handle it for about 30 seconds before he hung up, overwhelmed with the stark cold reality of mortality starting him in the face. Seeing the patient, not only dying, but dying by prolonged suffocating, was horrific. We gave several large doses of morphine to provide what comfort we could, and slow the breathing down a little. We took off the pressure mask, and placed a high powered nasal cannula at its highest settings.

    The family could really see his face now, and their voices changed to utter terrified agony. The sound of gasping grunting breathing was no longer muffled by the pressure mask. No words were going to come out of his mouth. Only the haunting sounds of a dying man. The nurse practitioner held one hand while the respiratory therapist held the other.

    The spouse started crying hysterically, shouting with a surprising fury in her voice: “NO! YOU CAN’T DO THIS TO ME! YOU CAN’T DO THIS TO US. IT WASN’T SUPPOSED TO BE LIKE THIS! WE WERE SUPPOSED TO GROW OLD TOGETHER! WE WERE SUPPOSED TO SIT ON THE PORCH IN OUR ROCKING CHAIRS! YOU CAN’T LEAVE US! YOU CAN’T LEAVE YOUR GRANDBABIES! PLEASE, GOD, PLEASE, NO! WE LOVE YOU!”

    Anger.

    We all quietly glanced at each other, and more morphine was given, along with more lorazepam. The rawness of the suffering being experienced by both the patient and the family sucker punched me in the gut. My focus on documentation, patient care, and support of the team swept to the side for a moment, and tears slipped out of my eyes and ran down onto the N95 mask under my face shield. My isolation gown and gloves felt like a sauna as I tried to keep my emotional composure. The pain of the family sucked at my soul.

    In medicine, death is usually our mortal enemy. The dark robed nemesis with a scythe who we fight at every turn. We spend billions of dollars a year in an eternal war against him with our patients. But death was now a white angel of mercy, the one who could bring peace into this torment and end this suffering. God, please let him die soon.

    The wife stopped shouting, and her words became less aggressive, but filled with soul-wrenching tears of genuine sadness. She sobbed as she said “This isn’t fair. It’s too soon. You weren’t supposed to go like this. You are too strong! You were supposed to be there when your grand daughter grows up and gets married. I don’t know how to live without you.”

    Depression/sorrow.

    The breathing started becoming sporadic, still gasping, but with less movement as the body lost all of its strength. Only the shoulders really moved now, heaving upwards for a few deep grunting breaths, then pausing for a few seconds.

    The reflexive task of breathing that started when the patient burst from the womb as a newborn had continued unabated through every minute of their life until now. A 2 second pause. A 5 second pause. A 10 second pause. The oxygen levels dropped below 30%. The heart rate began slowing. The children all hung up on the video call until only the spouse was left. “It’s okay, baby. It’s going to be okay. We love you. God loves you. We’ll be strong. We’ll be okay. God, help us be okay.”

    Acceptance

    We stood there, holding the patient’s hands as all effort to breath stopped. I quietly turned off the monitor alarms. The spouse was still talking to the patient, just saying sentences that had become meaningless filler, background noise more for the spouse than for him. We stepped back from the patient as the NP performed a quick pronouncement exam. He turned towards the iPad screen, made eye contact with the spouse, and simply stated, “he’s gone.”

    The grief, shock, and terror hit the spouse like a fresh ice cold wave of pain. In spite of the obvious inevitably of this moment for the last 45 minutes, she sounded truly surprised that it came. There were no more words. Just despondent heart wrenching wails of emotion. Raw inhumane pain.

    The staff whispered quietly to each other, and we agreed to leave them alone at this time. We spoke our condolences to the wife, and then walked out of the room, peeling off our layers of PPE. The primary nurse thanked me for my help. I glanced back into the room as I walked away. A cold grey lifeless body sitting in bed illuminated by the cold blue glow of the iPad on the stand next to them.

    I hustled to get back to my patients for the last 10 minutes of my shift. My Covid patient in his mid 60s had comfortably worn his AVAPS all night, and was wearing just a little bit of oxygen by regular nasal cannula now that he was awake and sitting up. I smiled as I told him that maybe he was over the hump, seeing as we had been able to make some progress on his oxygen requirements. He would probably leave the ICU today unless something drastically changed. I gave him a couple medications.

    I checked in on my Covid patient in his mid 30s. He was actually looking a little worse, his breathing had increased from a normal 20 to 25 breaths a minute to 30 to 35 breaths a minute, and looking a little anxious. We had been able to turn down the oxygen level on his high flow nasal cannula throughout the night, however. He told me that he’s just having a lot of coughing with pleuritic chest pain, that he thinks he’ll be fine. I wished him well and ducked back out of the room to give the end of shift report.

    I wish for a lot of things. I wish that we would all never take a single day for granted. I wish we would all hold those we love a little closer tonight. I wish Covid wasn’t still killing people daily. I wish that everyone could empathize with the grief that we all felt tonight. I wish that we could all learn to love each other a little more while we have time.

    ReplyReply
    4
  50. Just nutha ignint cracker says:

    @Mister Bluster:

    he was canceling the event due to “the total bias and dishonesty” of the media and the House select committee investigating Trump’s role in the Jan. 6 attack.

    I plugged that into Google Translate on detect language setting and got

    he was cancelling the event because ticket sales were too low to meet the rental fee for the venue

    I hope that’s correct, but Google Translate does not always hit it on the first try.

    ReplyReply
    3
  51. Just nutha ignint cracker says:

    @Jax: Eventually, the fact that his death was completely unnecessary is going to start gnawing at her.

    And she’s still not going to take the shot–what would be the point now?

    God moves in mysterious ways. One of the less mysterious ones is the laws of microbiology.

    ReplyReply
    1
  52. Jax says:

    @Just nutha ignint cracker: But, you know, her friend had a friend who got COVID and it was totally cured by Ivermectin. (eyeroll)

    So many lives (cough cough, living, breathing taxpayers) wasted.

    ReplyReply
    1

Speak Your Mind

*